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Systematic review of combination therapies for mycosis fungoides
Daniel Humme1, Alexander Nast1, Ricardo Erdmann1
1Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Background:
A variety of therapeutic options are available for mycosis fungoides, the most prevalent subtype of cutaneous T cell lymphomas, but thus far, no regimen has been proven to be curative. A combination of treatments is a well-established strategy to increase the therapeutic efficacy. However, data from clinical trials analyzing such combinations for the treatment of mycosis fungoides are scarce.
Objective:
To analyze the available evidence on combination therapies with emphasis on the combination of psoralen with UVA phototherapy (PUVA), interferon-alpha and bexarotene with another treatment.
Methods:
Systematic literature review of the databases Embase, Cochrane, Medline, and Medline in Process.
Results:
Combination of PUVA with interferon-alpha or retinoids did not result in an increased overall response rate. Addition of methotrexate but not retinoids to interferon-alpha may increase the overall response rate. Bexarotene was investigated in one trial each with vorinostat, methotrexate or gemcitabine, whereby only methotrexate possibly enhanced the effect of bexarotene.
Conclusion:
For mycosis fungoides, no combination treatment has been demonstrated to be superior to monotherapy. Based on our analysis, we conclude that in certain clinical situations, patients may benefit from a combination of PUVA with interferon-alpha or a retinoid or a combination of the latter two. Furthermore, patients in advanced stages may benefit from the combination of methotrexate and interferon-alpha or bexarotene. Finally, the combination of bexarotene with either vorinostat or gemcitabine did not increase the overall response rate but resulted in more pronounced side effects and cannot be recommended.
Insights
For mycosis fungoides, combination therapies show limited superiority over monotherapy. Certain combinations like PUVA with interferon-alpha or retinoids, and methotrexate with interferon-alpha or bexarotene, may benefit specific patient groups.
Area of Science:
- Dermatology
- Oncology
- Clinical Pharmacology
Background:
- Mycosis fungoides, a common cutaneous T-cell lymphoma, lacks curative treatments.
- Combination therapies are established for increasing efficacy, but clinical trial data are scarce.
Purpose of the Study:
- To review evidence on combination therapies for mycosis fungoides.
- Focus on psoralen with UVA phototherapy (PUVA), interferon-alpha, and bexarotene combinations.
Main Methods:
- Systematic literature review.
- Databases searched: Embase, Cochrane, Medline, and Medline in Process.
Main Results:
- PUVA combined with interferon-alpha or retinoids did not improve response rates.
- Methotrexate may enhance interferon-alpha response; retinoids did not.
- Bexarotene with methotrexate showed potential benefit, unlike with vorinostat or gemcitabine.
Conclusions:
- No combination therapy definitively surpasses monotherapy for mycosis fungoides.
- PUVA with interferon-alpha/retinoids and methotrexate with interferon-alpha/bexarotene may be beneficial in specific scenarios.
- Bexarotene combinations with vorinostat/gemcitabine are not recommended due to side effects.
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